Objective Pupillometry and Dexterity Assessment in Surgical Trainees: A Pilot Study

Area of Science:

• Surgical Education and Training
• Cognitive Science
• Biomedical Engineering

Background:

• Surgical skill acquisition relies on motor coordination and cognitive control.
• Existing assessment tools have variable predictive validity.
• Physiologic metrics like pupillometry offer objective measures of cognitive load.

Purpose of the Study:

• To develop a unified framework integrating dexterity metrics and pupillometry for surgical training assessment.
• To evaluate technical performance and cognitive load across different surgical training levels.
• To explore the relationship between objective performance and cognitive workload.

Main Methods:

• A pilot study involving 79 participants (medical students, controls, experts).
• Standardized dexterity tasks (Finger Dexterity, Tweezer Dexterity, knot-tying) and performance metrics (completion time).
• Cognitive load assessment using baseline-corrected pupil diameter (Δ-BCPD) synchronized with task time.

Main Results:

• Finger dexterity scores varied significantly by training level and correlated with knot-tying time.
• Pupillometry indicated lower cognitive load (Δ-BCPD) in experts and high-performing participants.
• High performers exhibited reduced cognitive load, suggesting task automation, particularly in fine motor tasks.

Conclusions:

• Dexterity tasks combined with pupillometry offer complementary insights into surgical performance and workload.
• This rater-independent framework shows potential for differentiating performance and characterizing task demands.
• Further validation in larger cohorts is recommended for this promising assessment approach.